Childhood sexual abuse and mental disorders
Sexual abuse experienced in childhood has been associated with increased levels of subsequent mental disorders Burnham, M.A., Stein, J.A. & Golding, J.M. (1988). Sexual assault and mental disorder in a community population. Journal of Consulting Psychology, 6, 843-850.Cahill, C., Llewelyn, S.P. & Pearson, C. (1991). Longterm effects of sexual abuse which ccured in childhood: A review. British Journal of Clinical Psychology, 30, 117-130. Child abuse has a causal role most mental health problems,including depression, anxiety disorders, PTSD, eating disorders, substance abuse, personality disorders, and dissociative disorders Anda R, Felitti V, Bremner D, Walker J, Whitfield C, Perry B, et al. The enduring effects of abuse and related adverse experiences in childhood. Eur Arch Psychiatry Clin Neurosci 2006;256(3):174-186. Kendler K, Bulik C, Silberg J, Hettema J, Myers J, Prescott C. Childhood sexual abuse and adult psychiatric and substance use disorders in women: an epidemiological and cotwin control analysis. Arch Gen Psychiatry 2000;57(10):953-959.Mullen P, Martin J, Anderson J, Romans S, Herbison G. Childhood sexual abuse and mental health in adult life. Br J Psychiatry 1993;163:721-732.Whitfield C. The truth about depression: Choices for healing. Health Communications,Inc.: Deerfield Beach (FL); 2003. Psychiatric patients subjected to childhood sexual or physical abuse have earlier first admissions and longer and more frequent hospitalizations, receive more medication, spend longer in seclusion, are more likely to self-mutilate, and have higher symptom severity. they are also are far more likely to try to attempt suicideLipschitz D, Winegar R, Nicolau A, Hartnick E, Wolfson M, Southwick S. Perceived abuse and neglect as risk factors for suicidal behavior in adolescent inpatients. J Nerv Ment Dis 1999;187(1):32-39.Roy A. Reported childhood trauma and suicide attempts in schizophrenia patients. Suicide Life Threat Behav 2005;35(6):690-693. *Childhood sexual abuse and depression *Childhood sexual abuse and PTSD *Childhood sexual abuse and sexual function disturbances *Childhood sexual abuse and psychosis Child sexual abuse has been identified as a predictor of future psychopathology,Dinwiddie S, Heath AC, Dunne MP, et al (2000). "Early sexual abuse and lifetime psychopathology: a co-twin-control study." Psychological Medicine, 30:41–52Nelson EC, Heath AC, Madden PA, et al (2002). "Association between self-reported childhood sexual abuse and adverse psychosocial outcomes: results from a twin study.," Archives of General Psychiatry, 59:139–145 though it has no characteristic pattern of symptoms.Fergusson, D.M. & Mullen, P.E. (1999). "Childhood sexual abuse: An evidence based perspective," Thousand Oaks, California: Sage Publications. Kendall-Tackett et al. (1993) and other studies found that a wide range of psychological, emotional, physical, and social effects are associated with child sexual abuse, including depression,Roosa M.W., Reinholtz C., Angelini P.J. (1999). "The relation of child sexual abuse and depression in young women: comparisons across four ethnic groups," Journal of Abnormal Child Psychology 27(1):65-76. post-traumatic stress disorder,Widom C.S. (1999). "Posttraumatic stress disorder in abused and neglected children grown up," American Journal of Psychiatry; 156(8):1223-1229. anxiety,Levitan, R. D., N. A. Rector, Sheldon, T., & Goering, P. (2003). "Childhood adversities associated with major depression and/or anxiety disorders in a community sample of Ontario: Issues of co-morbidity and specificity," Depression & Anxiety; 17, 34-42. poor self-esteem, somatoform disorders, complex post-traumatic stress disorder, emotional dysregulation, neurosis, and other more general dysfunctions such as sexualized behavior, school/learning problems, behavior problems and destructive behavior.Kendall-Tacket, K. A., Williams, L. M., & Finkelhor. D. (1993). Impact of Sexual Abuse on Children: A Review and Synthesis of Recent Empirical Studies. Psychological Bulletin, 1993, Vol. 113, No. 1, 164-180.Dozier, M., Stovall, K.C., & Albus, K. (1999) Attachment and Psychopathology in Adulthood. In J. Cassidy & P. Shaver (Eds.). Handbook of Attachment (pp. 497-519). NY: Guilford PressGauthier, L., Stollak, G., Messe, L., & Arnoff, J. (1996). Recall of childhood neglect and physical abuse as differential predictors of current psychological functioning. Child Abuse and Neglect 20, 549-559. A review of studies by Kendell-Tackett et al. found that two-thirds of the children who were sexually abused showed symptoms, but in comparison with children in treatment who were not sexually abused, the sexually abused children were less symptomatic for all measured symptoms except sexualized behavior. Caffaro-Rouget et al. (1989)Caffaro-Rouget, A., Lang, R. A. & vanSanten, V. (1989). The impact of child sexual abuse. Annals of Sex Research, 2, 29-47. found that 51% of their sample was symptomatic; in Mannarino and Cohen (1986),Mannarino, A. P. & Cohen, J. A. (1986). A clinical-demographic study of sexually abused children. Child Abuse and Neglect, 10, 17-23. 69% of forty-five assessed children were symptomatic; 64% of Tong, Oates, and McDowell's (1987)Tong, L., Oates, K. & McDowell, M. (1987). Personality development following sexual abuse. Child Abuse and Neglect, 11, 371-383. forty-nine child sample were not within the normal range on the child behavior checklist; and in Conte and Schuerman (1987),Conte, J. & Schuerman, J. (1987b). The effects of sexual abuse on children: A multidimensional view. Journal of Interpersonal Violence, 2, 380-390. whose assessment included both very specific and broad items such as 'fearful of abuse stimuli' and 'emotional upset,' 79% of the sample was symptomatic. A minority of abused children have been found to be healthy and asymptomatic, Rind, B., Tromovitch, Ph. & Bauserman, R. (1998). A Meta-analytic Examination of Assumed Properties of Child Sexual Abuse Using College Samples. Psychological Bulletin. 124(1), 22-53. http://www.tegenwicht.org/13_rbt_eng/rbt/metaana.htmBeitchman, J. H., Zucker, K. J., Hood, J. E., daCosta, G. A., Akman, D., & Cassavia, E. (1992). "A review of the long-term effects of child sexual abuse," Child Abuse & Neglect, 16, 101-118; and Beitchman, J. H.., Zucker, K. J., Hood, J. E., daCosta, G. A., & Akman, D. (1991). "A review of the short-term effects of child sexual abuse," Child Abuse & Neglect, 15, 537-556.Browne, A., & Finkelhor, D. (1986). "Impact of sexual abuse: A review of the research," Psychological Bulletin, 99, 66-77. and the level of harm associated with the abuse may correlate with other factors. Prescott and Kendler (2001) found that the risk of psychopathology increased if the perpetrator was a relative, if the abuse involved intercourse or attempted intercourse, or if threats or force were used. The age at which an individual was first abused did not appear to be related.Bulick, C. M., Prescott, C. A., & Kendler, K. S. (2001). "Features of childhood sexual abuse and the development of psychiatric and substance use disorders," British Journal of Psychiatry, 179, 444-449. Other studies have found that the risk of adverse outcomes is reduced for abused children who have supportive family environments.Romans, S., Martin, J., Anderson, J., et al (1995). "Factors that mediate between child sexual abuse and adult psychological outcome," Psychological Medicine, 25, 127-142.Spaccarelli, S. & Kim, S. (1995). "Resilience criteria and factors associated with resilience in sexually abused girls," Child Abuse and Neglect, 19, 1171-1182. Because child sexual abuse often occurs alongside other possibly confounding variables, such as poor family environment and physical abuse,Mullen, P. E., Martin, J. L., Anderson, J. C., Romans, S. E. and Herbison, G. P. (1996). "The long-term impact of the physical, emotional and sexual abuse of children: a community study," Child Abuse and Neglect, 20, 7 - 22. some scholars argue it is important to control for those variables in studies which measure the effects of sexual abuseKendler, K. S., Bulik, C. M., Silberg, J., Hettema, J. M., Myers, J., & Prescott, C. A. (2000). "Childhood sexual abuse and adult psychiatric and substance use disorders in women: An epidemiological and cotwin control analysis," Archives of General Psychiatry, 57, 953-959.Pope, H. G., & Hudson, J. I. (1995). "Does childhood sexual abuse cause adult psychiatric disorders? Essentials of methodology," The Journal of Psychiatry & Law, 23, 363-381.Levitt, E. E., & Pinnell, C. M. (1995). "Some additional light on the childhood sexual abuse-psychopathology axis," International Journal of Clinical and Experimental Hypnosis, 43, 145-162. and some have hypothesized "that abuse effects are at least in part the results of dysfunctional family dynamics that support sexual abuse and produce psychological disturbance (Fromuth, 1986) and that concomitant physical or psychological abuse may account for some of the difficulties otherwise attributed to sexual abuse (Briere & Runtz, 1990)."Briere, J. (1992). "Methodological issues in the study of sexual abuse effects," Journal of Consulting and Clinical Psychology, p. 199. Martin and Fleming, however, argue that, "in most cases, the fundamental damage inflicted by child sexual abuse is due to the child's developing capacities for trust, intimacy, agency and sexuality, and that many of the mental health problems of adult life associated with histories of child sexual abuse are second-order effects."Mullen, P. & Fleming, J. (1998). "Long-term effects of child sexual abuse," Issues in child abuse prevention (9). Australia: National Child Protection Clearing House. Rind et al.'s 1998 meta-analysis of studies using college student samples concluded that the relationship between poorer adjustment and child sexual abuse is generally found nonsignificant in studies which control for variables such as family environment and other forms of abuse. Other studies have found an independent association of child sexual abuse with adverse psychological outcomes.Kendler, K. S., Bulik, C. M., Silberg, J., Hettema, J. M., Myers, J., & Prescott, C. A. (2000). "Childhood sexual abuse and adult psychiatric and substance use disorders in women: An epidemiological and cotwin control analysis," Archives of General Psychiatry, 57 , 953-959. Kendler et al. (2000) found that most of the relationship between severe forms of child sexual abuse and adult psychopathology in their sample could not be explained by family discord, because the effect size of this association decreased only slightly after they controlled for possible confounding variables. Their examination of a small sample of CSA-discordant twins also supported a causal link between child sexual abuse and adult psychopathology; the CSA-exposed subjects had a consistently higher risk for psychopathologic disorders than their CSA non-exposed twins. After controlling for possible confounding variables, Widom (1999) found that child sexual abuse independently predicts the number of symptoms for PTSD a person displays. 37.5% of their sexually abused subjects, 32.7% of their physically abused subjects, and 20.4% of their control group met the criteria for a diagnosis of PTSD.The authors concluded, "Victims of child abuse (sexual and physical) and neglect are at increased risk for developing PTSD, but childhood victimization is not a sufficient condition. Family, individual, and lifestyle variables also place individuals at risk and contribute to the symptoms of PTSD." Mullen and Fleming, argue that, "in most cases, the fundamental damage inflicted by child sexual abuse is due to the child's developing capacities for trust, intimacy, agency and sexuality, and that many of the mental health problems of adult life associated with histories of child sexual abuse are second-order effects."Mullen, P. & Fleming, J. (1998). "Long-term effects of child sexual abuse," Issues in child abuse prevention (9). Australia: National Child Protection Clearing House. References Category:Childhood sexual abuse Category:Mental health